EFFECT OF SSRI ANTIDEPRESSANTS ON EJACULATION - A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED STUDY WITH FLUOXETINE, FLUVOXAMINE, PAROXETINE, AND SERTRALINE

Depression is a common cause of sexual dysfunction, but also antidepre ssant medication is often associated with sexual side effects. This ar ticle includes two related studies. The first double-blind, placebo-co ntrolled study was conducted in men with lifelong rapid ejaculation an d aimed to assess putative differences between the major selective ser otonin reuptake inhibitors (SSRIs) (fluoxetine, fluvoxamine, paroxetin e, and sertraline) with regard to their ejaculation-delaying effect. S ixty men with an intravaginal ejaculation latency time (IELT) of 1 min ute or less were randomly assigned to receive fluoxetine 20 mg/day, fl uvoxamine 100 mg/day, paroxetine 20 mg/day, sertraline 50 mg/day, or p lacebo for 6 weeks. During the 1-month baseline and g-week treatment p eriods, the men measured their IELT at home using a stopwatch. The tri al was completed by 51 men. During the 6-week treatment period, the ge ometric mean IELT in the placebo group was constant at approximately 2 0 seconds. Analysis of variance revealed a between-groups difference i n the evolution of IELT delay(p = 0.0004); in the paroxetine, fluoxeti ne, and sertraline groups there was a gradual increase to about 110 se conds, whereas in the fluvoxamine group, IELT was increased to only ap proximately 40 seconds. The paroxetine, fluoxetine, and sertraline gro ups differed significantly (p < 0.001, p < 0.001, p = 0.017, respectiv ely) from placebo but the fluvoxamine group did not (p = 0.38). Compar ed with baseline, paroxetine exerted the strongest delay in ejaculatio n, followed by fluoxetine and sertraline. There was no clinically rele vant delay in ejaculation with fluvoxamine. In men with lifelong rapid ejaculation, paroxetine delayed ejaculation most strongly, whereas fl uvoxamine delayed ejaculation the least. The second double-blind, plac ebo-controlled study was carried out in men with lifelong rapid ejacul ation (IELT less than or equal to 1 minute) and in men with lifelong l ess-rapid ejaculation (IELT > 1 minute) to investigate whether data ab out SSRI-induced delayed ejaculation in men with rapid ejaculation may be extrapolated to men with less-rapid ejaculation. After measurement of IELT at home (using a stopwatch) during a 1-month baseline assessm ent, 32 men with an IELT of 1 minute or less (group 1) or more than 1 minute (group 2) were randomly assigned to receive paroxetine 20 mg/da y or placebo for 6 weeks in a double-blind manner. Patients continued to measure their IELTs at home during the 6 weeks of the study. At bas eline, 24 patients consistently had IELTs of one minute or less (group 1), and eight patients had IELTs of more than 1 minute (group 2). The geometric mean IELT was 14 seconds in group 1 and 83 seconds in group 2. Twelve patients in group 1 and five in group 2 were randomized to the paroxetine 20 mg/day. The percentage increase in the geometric mea n IELT compared with baseline in patients treated with paroxetine was 420% (95% confidence interval [CI], 216-758%) in group 1 and 480% (95% CI, 177-1,118%) in group 2 (p = 0.81). After 6 weeks of treatment wit h paroxetine, the geometric mean IELT was 92 seconds in group 1 and 60 2 seconds in group 2 (p < 0.001). Therefore, the paroxetine-induced pe rcentage increase in IELT seems to be independent of the baseline IELT . This suggests that ejaculation-delaying side effects of some SSRIs i nvestigated in men with Lifelong rapid ejaculation may be generalized to men with less-rapid ejaculation.